POS0867 COMORBIDITY AND COMPLICATIONS PRIOR TO SYSTEMIC SCLEROSIS DIAGNOSIS: A RETROSPECTIVE COHORT ANALYSIS
Authors: D. Khanna, D. Furst, J. W. LI, S. Shah, T. Lesperance, F. Ali, B. Lamoreaux, S. Taylor
Journal: Annals of the Rheumatic Diseases (2022)

Background Systemic sclerosis (SSc) is a rare autoimmune disease characterized by progressive microvascular damage, collagen deposition and subsequent fibrosis of the skin and internal organs which contributes to substantial morbidity and premature death. 1-2 Objectives The objective was to evaluate the disease burden of SSc patients prior to their SSc diagnosis. Methods Patients with SSc were identified in a claims dataset (IBM MarketScan Commercial Database, 2015-2019) using ICD 10 diagnosis codes for SSc. Eligible subjects were required to have &gt; 1 inpatient or &gt;2 outpatient/office claims with a scleroderma diagnosis code on separate days and &gt; 24 months of continuous health plan enrollment without a SSc diagnosis before the first SSc claim (‘index date’) and &gt; 12 months of enrollment after the index date. Overall comorbid disease burden was assessed via the Charlson Comorbidity Index (CCI) 13-24 and 12 months before and 12 months after index date. The prevalence of SSc-related complications for atherosclerosis, pulmonary arterial hypertension (PAH), pulmonary fibrosis (PF), Raynaud’s Phenomenon (RP), and gastrointestinal (GI) complications (e.g., GERD, dysphagia, etc.) were identified using ICD codes and reported as percentages for the aforementioned time intervals relative to patients’ index dates. Results 902 eligible SSc patients were identified for analysis. The mean age at index SSc diagnosis was 54.3 years and 84.7% of patients were female. Mean CCI scores 13-24 months before, 12 months before, and 12 months after index SSc diagnosis were 0.84, 1.13 and 1.30, respectively. From the time points 13-24 months before, 12 months before, and 12 months after index SSc diagnosis, increasing rates were also observed of atherosclerosis, PAH, PF, RP, and GI complications (Table 1). Table 1. Charlson Comorbidity Index (CCI) and systemic sclerosis-related complications by time-interval Clinical characteristic 13-24 months before Index 12 months before Index 12 months after Index Mean CCI (std dev) 0.84 (1.58) 1.13 (1.71) 1.30 (1.75) Systemic sclerosis-related complications Atherosclerosis 7% 9% 14% Pulmonary arterial hypertension (PAH) 1% 4% 12% Pulmonary fibrosis (PF) 5% 8% 16% Raynaud’s Phenomenon (RP) 13% 29% 43% GI complications 23% 32% 46% Conclusion Results from this analysis suggests that SSc-related sequalae are present at least two years prior to SSc diagnosis and rates of these complications increased markedly over time. Patients’ overall comorbid disease burden also worsened substantially over this period, likely because of these complications. The internal organ involvement is likely under reported due to requirements to link each diagnosis with an ICD-10 code. These data indicate the significant burden of SSc, prior to and after diagnosis, highlighting the need for awareness, prompt diagnosis, and effective therapies for SSc and its related complications. References [1]Cutolo M, et al. Expert Rev Clin Immunol. 2019;15(7):753-764. [2]Steen VD, Medsger TA. Ann Rheum Dis. 2007;66(7):940-944. Disclosure of Interests Dinesh Khanna Consultant of: Horizon Therapeutics, Daniel Furst Consultant of: Horizon Therapeutics, Justin W. Li Grant/research support from: Horizon Therapeutics, Saloni Shah Grant/research support from: Horizon Therapeutics, Tamara Lesperance Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Farah Ali Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Brian LaMoreaux Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Stephanie Taylor Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics